Junctional ectopic tachycardia following complete heart block associated with viral myocarditis.

We describe the case of an infant progressing from sinus rhythm to complete heart block, junctional ectopic tachycardia, and back to sinus rhythm as the only manifestation of viral myocarditis.

Purulent pericarditis in a neonate.

A 10-day-old male infant presented with rapid and labored breathing to an outside hospital. An echocardiogram demonstrated a thick, non-free-flowing pericardial effusion. A blood culture drawn grew Escherichia coli. The patient underwent a pericardectomy and pericardial drainage. Samples were taken for acid-fast bacilli, cytomegalovirus antigenemia, fungal, and fluid cultures, all of which were negative. A repeat echocardiogram demonstrated resolution of the pericardial effusion. Antibiotic therapy alone is insufficient to treat purulent pericarditis. The successful treatment of purulent pericarditis requires the combination of pericardial decompression with open drainage and appropriate antibiotic therapy.

Eosinophilic myocarditis presenting with pediatric myocardial infarction.

Determination of the etiology of myocardial infarction (MI) in children can present a challenge to the practitioner since cases of pediatric MI are rare and the causes can be diverse. We report an unusual case of pediatric eosinophilic myocarditis that presented with MI.

Chronic outpatient sildenafil therapy for pulmonary hypertension in a child after cardiac surgery.

We report the case of a 14-month-old male with d-transposition of the great arteries, ventricular septal defect, and pulmonary hypertension successfully treated with long-term sildenafil following cardiac surgery. To our knowledge, this is the first published report of long-term sildenafil treatment in a child after corrective cardiac surgery.

Second-line treatment of fetal supraventricular tachycardia using flecainide acetate.

Digoxin has been an effective treatment for fetal supraventricular tachycardia (SVT), but second-line therapy remains more controversial. Thirty-seven cases of fetal SVT were identified that received digoxin as first-line therapy. Seventeen fetuses (46%) converted to and maintained normal sinus rhythm. Flecainide was used in 13/15 patients requiring second-line therapy; 12/13 (92%) converted to sinus rhythm. Of seven hydropic fetuses, five required second-line therapy and were then successfully converted with flecainide. The improved efficacy of flecainide was statistically significant with a p value <0.01. Complete follow-up was available in 13 digoxin-treated and in 12 second-line therapy infants. Prolonged or multiple drug therapy for postnatal arrhythmia management was required in 3/13 (23%) patients in the digoxin group and in 8/12 (67%) patients requiring second-line therapy. This demonstrated a correlation between the need for second-line fetal therapy and more complex postnatal management with a p value of 0.003. Digoxin remains an effective first-line therapy in the treatment of fetal SVT. Flecainide is an effective second-line therapy, especially in the face of fetal hydrops. Use of second-line therapy in fetal SVT is a predictor of complex postnatal course, and these patients should be followed more closely.

Late onset of pulmonary hypertension after successful Mustard surgery for d-transposition of the great arteries.

Late-onset pulmonary hypertension is a serious complication of Mustard repair for d-transposition of the great arteries. This debilitating complication occurs in 7% of patients who survive to adulthood, even in the face of normal or near-normal postoperative pulmonary pressure.